RENAL FUNCTIONTEST  Creatinine—waste product of muscle metabolism that isproduced

enzymatically by creatinine phosphokinase from creatinine.

Overview
CCT Significance:
 Renal physiology shows that there are many metabolic functions
and chemical interactions to be evaluated through laboratory GFR –Determines the functional capacity of nephrons—nutrition rate
tests of renal function.
 Parts of the nephron are related to the laboratory tests used to Creatinine clearance
assess their function.
 Laboratory tests are used to asses the function of the  Determines the extent of nephron damage in known cases of
nepthron, from glumerolus to different areas inkidney renal disease.
 Monitor the effectiveness of treatment
GLOMERULAR FILTRATION RATE: CLEARANCE TEST  Determines the feasibility of administering medications
(not useful as indication for early renal disease)  Cheaper compared to other tests

CLEARANCE TEST Disadvantage of CCT:

 The standard tests used to measure the filtering capacity of the  Some Creatinine secreted by tubule—increase level of creatinine
glomeruli  Chromogens present in human plasma—reaction in chemical
 Measures the rate at which the kidneys are able to remove (to analysis causes for a false positive
clear) a filterable substance from the blood.  Some medications causes false decreased value (gentamicin,
 The substance analyzed must be one that is neither reabsorbed cephalosporins, and cimetidine (Tagamet)—inhibit rubular
nor secreted by the tubules. secretion
 Creatinine and BUN  Creatinine breakdown by some bacteria
 Stability of substance in urine during 24- hour urine collection  influenced by heavy diet—3 days Meat diet—False increase
 Consistency of plasma level  Interference by muscle wasting disease.
 Include: advantage / disadvantage interfering substances  Must be corrected and accuracy would depend on the
 Substances availability to the body completeness of collection of 24 hour
 Availability of tests for analysis of the substance
 Reported in mL/min CREATININE CLEARANCE NOTE: Blood Chemistry Section--CC
1. UREA CLEARANCE TEST
 STANDARD METHOD for GFR UC UV (ml) 1.73
 Demonstrate progression of renal disease or response to clearance= x x
PC minutes A
therapy
 Poor GFR—clinical significance but the normal value were UC= URINE CREA; PC= PLASMA CREA;
adjusted to regret the reabsorption UV= URINE VOLUME; MINUTES= 1440(mins.)
 Not give reliable estimates of GFR (Approximately 40% of filtered A= Body surface of patient; 1.73= Standard body surface
urea is reabsorbed)
 It is about 50% of creatinine clearance.
 The earliest glomerular filtration tests
 normal values were adjusted to reflect there absorption, and
patients were hydrated to produce a urine flow of 2 mL/min to
ensure that no more than 40% of the urea was reabsorbed
 oldest GF test—considered as standard method
 Too high, something wrong in the GFR
2. INULIN CLEARANCE TEST
 REFERENCE METHOD for GFR  average person (1.73 m2 body surface) the approximate amount
 Not routinely done because of the necessity for continuous IV of plasma filtrate produced per minute is 120 mL,
infusion  normal creatinine clearance values approach 120 mL/min
 Higher values in male due to larger renal mass  (men, 107 - 139 mL/min)
 PRIMING DOSE: 25 mL of 10% Inulin solution (initial dose)  women, 87 to 107 mL/min).
 CONTINUOUS INFUSION: 500 mL of 1.5% inulin solution  The normal reference range of plasma creatinine is 0.5 - 1.5
 REFERENCE VALUES: mg/dL
 127 mL/ min  Male (higher—due to larger renal mass)  Remove foams and bubbles
 118 mL/ min  Female
 Inulin- polymer of fructose—extremely stable substance that is
not reabsorbed or secreted by the tubules
 It is not a not normal body constituent
3. CREATININE CLEARANCE
 Most commonly used; screening method of GFR
 Excellent measurement of renal function
 Most frequent test –chemistry laboratory
 creatinine is freely filtered by the glomerulus but not
reabsorbed.
 A measure of the completeness of a 24 hour urine collection.
(reliable to achieve the accuracy of the result—must be exact)
 REFERENCE VALUES:
 85-125 mL/ min  Male
 75- 112 mL/ min Female
4. Estimated Glomerular Filtration Rates (eGFR) 7. Radionucleotides
 Founding innovation—FFDI or laboratories with  injecting radio nucleotides such as 125 - iothalamate provides a
specialization for the kidney function test method for determining glomerular filtration through the
 used for routinely screening patients as part of a metabolic plasma disappearance of the radioactive material and enables
profile visualization of the filtration in one or both kidneys
 to monitor patients already diagnosed with renal disease or at  This procedure can be valuable to measure the viability of a
risk for renal disease. transplanted kidney
 Have diabetes or cardiovascular disease  Rare-costly—not routine but Selective
 In addition, the formulas are valuable when medications that
require adequate renal clearance need to be prescribed. TUBULAR REABSORPTION TESTS
 Modification of Diet in Renal Disease (MDRD)
 MDRD-IDMS-(Isotope dilution mass spectrometry)—traceable 1. CONCENTRATION TEST
formula - National Kidney Disease Education Program (NKDEP)  Ability of the tubules to reabsorb the essential salts and water
 Specific or Specialize treatment –imbed with spectrometry- that have been nonselectively filtered by glomerulus
for exact computation (automated)  The specific gravity of urine before entering the renal tubules is
 Effective test for chronic kidney diseases CKD. 1.010, the specific gravity will vary when the urine enters the
 Discrepancy due to four variables: sex, age, serum renal tubules for the reabsorption process
creatinine, ethnicity

Stages of Chronic Kidney Disease

SPECIFIC GRAVITY

1) FISHBERG TEST - Patients were deprived of fluids for 24 hours

prior to measuring specific gravity
2) MOSENTHAL TEST - Compare the volume and specific gravity of
urine of day and night urine samples (compare concentration)
 Both test are not recommended as of today, there are other
tests that is more sensitive and specific for concentration
2. Osmolality
 End Kidney Failure—End stage of kidney failure—no filtration—  measures only the number of particles in a solution,
subject for dialysis. Sometimes 1000 result  specific gravity is influenced by the number and density
 Creatinine color- Canary Yellow –high—color Carotene (molecular weight) of the particles.
5. CYSTATIN C  Most sensitive
 Indirect estimate of GFR  Refractive Index, Density or Hydrometer, EK
 A low molecular weight protease inhibitor  Renal concentration is concerned with small particles, primarily
 Completely reabsorbed by the PCT, hence its presence in urine sodium and chloride molecules
denotes damage to the tubules  Large molecular-weight molecules such as glucose and urea do
 SPECIMEN: Serum or plasma (fasting is not required ) not contribute to the evaluation of renal concentration.
 INCREASED LEVELS: Acute & Chronic Renal failure, Diabetic  osmolality is performed for a more accurate evaluation of renal
nephropathy concentrating ability
 METHOD: Immunoassay
 Cystatin C is a small protein (molecularweight13,359) produced
at a constant rate by all nucleated cells.
 It is readily filtered by the glomerulus and reabsorbed and
broken down by the renal tubular cells
 good procedure for screening and monitoring GFR.
 GFR not useful for early detection of renal disease—but the
capacity of tubule to reabsorption
6. BETA 2 MICROGLOBULIN
 Dissociates from human leukocyte antigens at constant rate and
is rapidly removed from the plasma by glomerular filtration.
 A rise has been shown to be more sensitive indicator of
decrease in GFR than creatinine clearance.  Polyuria in Diabetes Insipidus—normally have high osmolality
 Not reliable in patients who have history of immunologic  ADH challenge—administration of ADH to the patient after 2
disorders or malignancy hours and 4 hours, they collect urine and the serum
 METHOD: EIA—Enzyme Immuno Assay  Normal—patient is not capable of producing ADH: >800
 Abnormal—Renal tubule is not responding with ADH
 1) FREEZING POINT OSMOMETERS
 Principle: Measurement of freezing point depression
Freezing point
 Temperature at which water and ice are in
equilibrium and is related to solute concentration
 Standard reference: NaCl
2) VAPOR PRESSUREOSMOMETER
 Principle: Measurement of dew point (Temperature at
which water vapor condenses to a liquid)
 Standard reference: NaCl
 Vapor pressure osmometers are used primarily to
analyze serum and sweat micro samples for disorders
not related to renal function, such as cysticfibrosis.
They are used primarily in the chemistry department
 Special kindey Laboratory or renal Laboratory

TUBULAR SECRETION & RENAL BLOOD FLOW TEST

 Tests to measure tubular secretion of nonfiltered substances

and renal blood flow
 Contrasting arrow of constriction going to the blood
and secretion from blood to tubule
 Impaired tubular secretory ability or inadequate presentation of
the substance to the capillaries owing to decreased renal blood
flow may cause an abnormal result.
1. p-aminohippuric acid (PAH) test.
 test most commonly associated with tubular secretion and renal
blood flow
 PSP—Phenolsulfonphthalein—used to evaluate
 Disadvantage: using a dye –that must be excreted due
to injected or administered—old and traditional test
 Interpretation or standardization—difficult (esp. medication)
 PAH Test: To measure the exact amount of blood flowing
through the kidney, it is necessary to use a substance that is
completely removed from the blood (plasma) each time it comes
in contact with functional renal tissue
 Some individual are sensitive to the test
 Not recommended
2. Titratable Acidity and Urinary Ammonia
 H+  Secretion
 NH3 (Ammonia)  Production & secretion
 Titratable acid (H+ ) - A normal person excretes approximately
70 mEq/day of acid
 H2PO4—Hydrogen Phosphate Ion
 NH4—Ammonium Ion
 Alakaline tides (diurnal variation) 2pm – 8pm
 Lowest pH: Night (acidic)

RENAL TUBULAR ACIDOSIS

 The inability to produce an acid urine in the presence of

metabolic acidosis
 This condition may result from impaired tubular secretion of
hydrogen ions associated with the proximal convoluted tubule-
defects in ammonia secretion associated with the distal
convoluted tubule.